Part D subscribers likely to see drug choices diminish

WASHINGTON Beneficiaries of Medicare Part D are likely to see their drug choices drop next year, as the government has culled hundreds of products from a list of approved drugs.

On average, the number of drugs offered by the 10 insurers with the largest enrollment shrank by 26 percent from this year to next, according to data analyzed by Washington consulting firm Avalere Health. Four of the top five plans have seen their drug coverage cut by at least 30 percent.

UnitedHealth and Humana both saw drops from more than 3,750 drugs to just more than 2,620, Avalere’s analysis shows. Even so, the two insurers still have among the largest drug lists of the 10 biggest insurers. UnitedHealth spokesman Daryl Richard pointed out that even with the drop, the company’s Medicare Rx Preferred plan covers “100 percent of the drugs” on Medicare’s approved list.

The drop came mainly because of changes made by Medicare, which shrank the list of drugs it will pay for, culling those that have been pulled by the FDA, are no longer being made, had duplicative billing codes or were drugs deemed “less than effective” by the FDA.

Medicare officials and the insurers say most beneficiaries are unlikely to be affected. Enrollees taking drugs that were pulled will usually be able to find alternates or can go through an appeals process to try to stay on their current drugs, they said.

“Most of those [removed] drugs were not used,” said Jeff Kelman, chief medical officer for Medicare’s Center for Beneficiary Choices, in a USA Today article.

“As the Part D program develops, the size of the formulary is becoming more aligned with utilization patterns, consumer preferences, health outcomes and value for consumers,” Humana spokesman Tom Noland said.

Avalere’s Jon Glaudemans said the enrollees should check the drug lists of plans they are considering before signing up, to see if the medications they take are included. The deadline for enrolling is Dec. 31. “Every year, insurers revise their formularies, and every year, beneficiaries should reassess their choices,” he said.